老年患者踝臂指数与冠状动脉疾病复杂性的关系。
Relation between the ankle-brachial index and the complexity of coronary artery disease in older patients.
机构信息
Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil.
出版信息
Clin Interv Aging. 2013;8:1611-6. doi: 10.2147/CIA.S52778. Epub 2013 Dec 2.
BACKGROUND
In the elderly, the ankle-brachial index (ABI) has greater than 90% sensitivity and specificity for peripheral artery disease identification. A well-known relation exists between peripheral artery disease and the number of diseased coronary vessels. Yet, other anatomical characteristics have important impacts on the type of treatment and prognosis.
PURPOSE
To determine the relation between ABI and the complexity of coronary artery disease, by different anatomical classifications.
METHODS
This study was a prospective analysis of patients ≥65 years old who were undergoing elective coronary angiography for ischemic coronary disease. The ABI was calculated for each leg, as the ratio between the lowest ankle pressure and the highest brachial pressure. The analysis of coronary anatomy was performed by three interventional cardiologists; it included classification of each lesion with >50% diameter stenosis, according to the American Heart Association criteria, and calculation of the SYNTAX score.
RESULTS
The study recruited 204 consecutive patients (median age: 72.5 years). Stable angina was present in 51% of patients. Although only 1% of patients reported peripheral artery disease, 45% exhibited an abnormal ABI. The number of lesions per patient, the number of patients with complex lesions, and the median SYNTAX scores were greater in the group with abnormal ABI. However, among 144 patients with obstructive coronary artery disease, despite abnormal ABI being able to identify a higher rate of patients with B2 or C type lesions (70.9% versus 53.8%; P=0.039), the mean SYNTAX scores (13 versus 9; P=0.14), and the proportion of patients with SYNTAX score >16 (34.2% versus 27.7%; P=0.47), were similar, irrespective of ABI.
CONCLUSION
In patients ≥65 years old the presence of peripheral artery disease could discriminate a group of patients with greater occurrence of B2 and C type lesions, but similar median SYNTAX score.
背景
在老年人中，踝臂指数（ABI）对周围动脉疾病的识别具有超过 90%的敏感性和特异性。众所周知，周围动脉疾病与病变冠状动脉的数量之间存在关联。然而，其他解剖学特征对治疗方式和预后有重要影响。
目的
通过不同的解剖分类，确定 ABI 与冠状动脉疾病复杂性之间的关系。
方法
这是一项对≥65 岁因缺血性冠状动脉疾病行选择性冠状动脉造影的患者进行的前瞻性分析。为每条腿计算 ABI，即最低踝压与最高肱动脉压的比值。由 3 名介入心脏病专家对冠状动脉解剖进行分析；根据美国心脏协会的标准，对每个狭窄程度超过 50%的病变进行分类，并计算 SYNTAX 评分。
结果
该研究共纳入 204 例连续患者（中位年龄：72.5 岁）。51%的患者有稳定型心绞痛。尽管只有 1%的患者报告有外周动脉疾病，但 45%的患者存在 ABI 异常。ABI 异常组的患者病变数量、复杂病变患者数量和中位数 SYNTAX 评分均较高。然而，在 144 例有阻塞性冠状动脉疾病的患者中，尽管 ABI 能够识别出更高比例的 B2 或 C 型病变患者（70.9%比 53.8%；P=0.039），但平均 SYNTAX 评分（13 比 9；P=0.14）和 SYNTAX 评分>16 的患者比例（34.2%比 27.7%；P=0.47）相似，与 ABI 无关。
结论
在≥65 岁的患者中，外周动脉疾病的存在可以区分出一组更常发生 B2 和 C 型病变的患者，但 SYNTAX 评分中位数相似。
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